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This study aimed to provide updated evidence on the status of female breast cancer and cancer treatment facilities in Asia, with a special focus on Nepal. This review used search phrases that included, breast neoplasm or cancer, health status, epidemiology, breast cancer survivors, cancer care facilities, Asia, Nepal. Researchers examined databases from January 2011 to December 2020 (PubMed, PMC, Google Scholar, and the reference lists of included papers). Studies of any design and reviews, were included in the study, except for qualitative studies. The study findings are presented in a narrative synthesis format using Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews. An initial search resulted in 974 papers, and 896 were reviewed after being checked for duplication using the Zotero software. Accordingly, utilizing the inclusion and exclusion criteria, 188 publications were selected, and after review of titles and abstracts, an additional 98 papers were removed for different reasons. Finally, the study looked at 90 female breast cancer papers. Results showed that the number of cases of breast cancer is growing all around the world, including in Asia and Nepal. Age, early menarche, late menopause, nulliparity, positive family history, excessive fat consumption, alcohol, and smoking are all frequent risk factors for breast cancer found in Asian women. Breast self-examination, clinical breast examination, and mammography screening are common methods for detecting breast carcinoma. Chemotherapy, radiation, and modified mastectomy are commonly used options for treatment. The number of breast cancer survivors is growing throughout the world, indicating better clinical care. There is a paucity of survival data in many Asian countries, including Nepal. There is also a scarcity of health workforce specialized in cancer care and treatment, as well as a few health facilities that are available to treat cancer cases in many Asian countries, including Nepal. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, governments and researchers have used routine health data to estimate potential declines in the delivery and uptake of essential health services. This research relies on the data being high quality and, crucially, on the data quality not changing because of the pandemic. In this paper, we investigated those assumptions and assessed data quality before and during COVID-19. Methods: We obtained routine health data from the DHIS2 platforms in Ethiopia, Haiti, Lao People's Democratic Republic, Nepal, and South Africa (KwaZulu-Natal province) for a range of 40 indicators on essential health services and institutional deaths. We extracted data over 24 months (January 2019–December 2020) including pre-pandemic data and the first 9 months of the pandemic. We assessed four dimensions of data quality: reporting completeness, presence of outliers, internal consistency, and external consistency. Results: We found high reporting completeness across countries and services and few declines in reporting at the onset of the pandemic. Positive outliers represented fewer than 1% of facility-month observations across services. Assessment of internal consistency across vaccine indicators found similar reporting of vaccines in all countries. Comparing cesarean section rates in the HMIS to those from population-representative surveys, we found high external consistency in all countries analyzed. Conclusions: While efforts remain to improve the quality of these data, our results show that several indicators in the HMIS can be reliably used to monitor service provision over time in these five countries. [ABSTRACT FROM AUTHOR]

Background In South Asia, women often experience intimate partner violence (IPV) and have limited access to maternal health services (MHS). However, the effects of IPV on antenatal care (ANC) visits remain unclear. This study aimed to examine the impact of IPV of different forms and severities on ANC visits in South Asia. Methods This cross-sectional study used the latest available data from demographic and health surveys conducted in Bangladesh, India, Afghanistan, Nepal, Maldives, and Pakistan. The study sampled 4467 women who had given birth within the past 12 months and were interviewed for IPV. IPV was measured by binary variables indicating the presence of physical violence (PV), categorised into less severe (LSPV) and severe physical violence (SPV), emotional violence (EV), and sexual violence (SV). ANC utilization was measured using binary variables indicating whether respondents had any, at least four, or at least eight ANC visits, as recommended by World Health Organization (WHO). Logistic regressions adjusted for survey weights were used to assess associations between ANC utilization and exposure to IPV during pregnancy and lifetime. Results The prevalence of LSPV, SPV, EV, and SV during pregnancy were 14.5%, 4.4%, 11.6%, and 4.1%. LSPV experience during pregnancy was associated with decreased likelihoods of at least four ANC visits (odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.40-0.76) and eight ANC visits (OR = 0.53; 95% CI = 0.31-0.90). Results of lifetime exposure to IPV followed similar patterns. Lifetime exposure to LSPV was associated with decreased likelihoods of at least four ANC visits (OR = 0.55; 95% CI = 0.41-0.74) and eight ANC visits (OR = 0.47; 95% CI = 0.29-0.77). Conclusion This study highlights the negativities of LSPV on the frequency of women seeking ANC visits. Policies are necessary to identify women at risk of the often-overlooked LSPV early and provide protective interventions to promote maternal health in South Asia. [ABSTRACT FROM AUTHOR]

This paper aims to describe the prevalent forms of intimate partner violence (IPV), and the factors associated with IPV among women and men living in the two migrant communities of Baglung district, Nepal. 357 adult women and men were enrolled following a family model, interviewing young married women with daughter-in-law status in the home, their husbands, and mothers-in-law and fathers-in-laws using an electronic questionnaire. Random effects regression modelling compared men and women, as well as young married women with daughter-in-law status and older women with mothers-in-law with status. 28.6% of women had ever experienced physical and/or sexual violence by an intimate partner compared to 18.2% of men ever perpetrated these forms of violence against their wives. Being older, male controlling behaviour and poor relations with husband increased women’s IPV in their lifetime while perceptions that the mother-in-law is kind were protective. Being ashamed of being unemployed and childhood trauma were associated with men perpetrating IPV in their lifetime. Borrowing money or food increased young married women’s lifetime IPV risk while mother-in-law cruelty and male control increased older married women’s lifetime IPV exposure. Factors associated with IPV in the past year among men were being younger, job seeking, experiences of childhood trauma and depression exposure among men while difficulty accessing money for emergencies, holding inequitable gender attitudes, and depression was associated with women’s increased IPV exposure. Unemployment stress, holding inequitable gender attitudes and mother-in-law kindness were associated with young women’s increased IPV risk and hunger, mother-in-law cruelty and depression with older women’s IPV risk. There is a need to critically challenge harmful social and gender norms by using approaches that are sensitive to young married women’s position and unequal gender relations in the family. IPV prevention interventions need to employ a holistic approach that combines changing social and gender norms and improving socioeconomic conditions of women living in migrant communities. [ABSTRACT FROM AUTHOR]

The M w 7.9 2015 April 25 Gorkha earthquake is the latest of a millenary-long series of large devastating Himalayan earthquakes. It is also the first time a large Himalayan earthquake and its aftershocks were recorded by a local network of seismic stations. In the 5 yr following the main shock, more than 31 000 aftershocks were located by this permanent network within the ruptured area, including 14 362 events with M L greater than 2.5, 7 events with M L > 6, including one large aftershock with M w 7.2 on 2015 May 12. In 2020, 5 yr after the main shock, the seismicity rate along the ruptured fault segments was still about 5 times higher than the background seismicity before the Gorkha earthquake. Several bursts of earthquakes, sometimes organized in clusters, have been observed from a few days to several years after the main shock. Some of these clusters were located at the same place as the clusters that happened during the decades of interseismic stress build-up that preceded the large earthquake. They also happened in the vicinity of the high frequency seismic bursts that occurred during the main shock. These heterogeneities contribute to a persistent segmentation of the seismicity along strike, possibly controlled by geological structural complexities of the Main Himalayan Thrust fault. We suggest that these pre-2015 clusters revealed the seismo-geological segmentation that influences both the coseismic rupture and the post-seismic relaxation. [ABSTRACT FROM AUTHOR]

This article critically evaluates the conventional Kanchan Arsenic Filter (KAF) in order to determine the main reasons for its reported poor performance. The KAF was introduced in 2004 in Nepal and makes use of non-galvanized nails as a Fe0 source for As removal. As early as 2009, the KAF was demonstrated to be ineffective for As removal in many cases. This was unambiguously attributed to the Fe0 layer which is placed on top of a sand filter instead of being incorporated into a sand matrix. Despite this conceptual mistake, the conventional KAF has been largely distributed in Asia, and recent articles have assessed its sustainability. This study reiterates that the suitability of the technology, rather than its sustainability, should be addressed. Evidence shows that the KAF has the following design limitations: (i) uses iron nails of unknown reactivity, and (ii) operates on the principle of a wet/dry cycle. The latter causes a decrease in the corrosion rate of the used nails, thereby limiting the availability of the iron corrosion products which act as contaminant scavengers. Taken together, these results confirm the unsuitability of the conventional KAF. Besides correcting the design mistakes, more attention should be paid to the intrinsic reactivity of the used iron nails, including using alternative Fe0 materials (e.g., iron filings, steel wool) for filters lasting for just 6 or 18 months. Specific design considerations to be addressed in the future are highlighted. [ABSTRACT FROM AUTHOR]

Night blindness during pregnancy caused by vitamin A deficiency is associated with an increased risk of morbidity and mortality among women. Because a history of maternal night blindness is simple and reliable to use, it is recommended as a population-based indicator of vitamin A deficiency. Furthermore, a maternal night blindness prevalence of >/=5% is recommended as a cut-off at which vitamin A deficiency may be considered to be a problem of public health significance within the community. This paper provides the justification for these recommendations. Night blindness during pregnancy is strongly associated with low serum and breast milk vitamin A concentration, abnormal conjunctival impression cytology and impaired dark adaptation, which suggests that it is a valid indicator of vitamin A deficiency. The prevalence of night blindness during pregnancy tends to be high in countries where the prevalence of xerophthalmia in children is high and in countries where interventions are in place to reduce childhood vitamin A deficiency. Existing data suggest that misclassification of self-reported maternal night blindness may account for a prevalence of up to 3%. The suggested cut-off, 5%, is set higher than this potential level of false-positive prevalence (3%). Illustrative data from India and Cambodia on childhood xerophthalmia and maternal night blindness rates are used to demonstrate the validity of using a 5% prevalence of maternal night blindness as indicative of a community vitamin A deficiency problem. Finally, it is recommended that night blindness history be elicited for a previous pregnancy that ended in a live birth in the past 3 y, using the local term for night blindness whenever possible. [ABSTRACT FROM AUTHOR]

Background: Nepal recorded 5754 suicides in 2018-19 - a high number for a relatively small country. Over 24% of these suicides were by poisoning, most by ingestion of highly concentrated agricultural pesticides. Nepal has actively regulated pesticides to reduce their health impacts since 2001. We aimed to analyse Nepal's history of pesticide regulation, pesticides responsible for poisonings, and relate them to national suicide rates.Methods: Information on pesticide regulation was collected from the Plant Quarantine and Pesticide Management Centre of the Ministry of Agriculture and Livestock Development. National data on suicides from 1980 to 2019 were obtained from the National Statistical Bureau and Nepal Police. Data on the pesticides responsible for self-poisoning and pesticide suicides over time were obtained from a systematic literature review.Results: As of June 2020, 171 pesticides were registered for use in Nepal, of which one was extremely hazardous (WHO Class Ia), one other highly hazardous (WHO Class Ib), and 71 moderately hazardous (WHO Class II). Twenty-four pesticides have been banned since 2001, with eight (including five WHO Class I compounds) banned in 2019. Although the suicide rate has increased more than twelve-fold since 1980, particularly for hanging (15-fold increase from 1980 to 2018), fatal pesticide self-poisoning has increased by 13-fold. Methyl-parathion is reported to be the key pesticide responsible for pesticide self-poisoning in Nepal, despite being banned in 2006.Conclusion: The full effect of the recent pesticide policy reform in Nepal remains to be seen. Our analysis shows a continuing increase in suicide numbers, despite bans of the most important pesticide in 2006. This may indicate smuggling across the border and the use of the brand name (Metacid) for pesticides in general making it difficult to identify the responsible pesticide. More information is required from forensic toxicology labs that identify the individual compounds found. The effect of recent bans of common suicide pesticides needs to be monitored over the coming years. Evidence from other Asian countries suggests that HHPs bans will lead to a marked reduction in suicides, as well as fewer cases of occupational poisoning. [ABSTRACT FROM AUTHOR]

Anemia is a condition in which the number of red blood cells is not sufficient to meet the physiological need of the body. Women of reproductive age and pregnant women are at a high risk of anemia, which in turn may contribute to maternal morbidity and mortality. We aimed to describe the prevalence of anemia and the factors associated with the risk of developing anemia in women of reproductive age in Nepal. Additionally, we examined the association of women’s decision-making autonomy regarding healthcare and experience of intimate partner violence (IPV) with anemia. Data from the 2016 Nepal Demographic and Health Survey (NDHS) were used in this study. The data were adjusted for sampling weight, stratification, and cluster sampling design. A battery-operated portable HemoCue was used to measure hemoglobin and detect anemia. Using complex sample logistic regression, the association between dependent and independent variables were examined; crude and adjusted odds ratio were reported. The mean (± SD) hemoglobin concentration was 12.13 g/dL (± 1.48). Overall, about 41% (95% CI 38.6–43.0%) of women aged 15–49 years were anemic. Women in households with wells as the source of drinking water (aOR 1.93; 95% CI 1.58–2.37) were significantly associated with an increased risk of developing anemia. While women who were currently using hormonal contraceptives (aOR 0.63, 95% CI 0.52–0.76) were significantly less likely to be anemic. After adjusting for background characteristics among women who were married at the time of the survey, decision-making autonomy regarding healthcare, and experience of IPV did not have a significant association with anemia. The high prevalence of anemia suggests the need for substantial improvement in the nutritional status of women. The increased disease burden compared with the past survey highlights the needs to reconsider the existing nutritional policy in Nepal. [ABSTRACT FROM AUTHOR]

Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- and -middle income countries, members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions. A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups such as Dalits, Madhesi, Muslim, Chepang and Tamang. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres. We conclude that community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups, and the programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the FCHVs and local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in low- and -middle income countries. [ABSTRACT FROM AUTHOR]

Background: While Nepal’s maternal mortality ratio (MMR) has improved overall, the proportion of maternal deaths occurring in health facilities and attended to by skilled birth attendants (SBAs), has nearly doubled over 12 years. Although there are numerous socioeconomic, environmental and other factors at play, one possible explanation for this discrepancy between utilization of skilled maternal care services and birth outcomes lies in the quality of care being provided by SBAs. The objective of this study is to determine how competent SBAs are after training, across multiple settings and facility types in Nepal. Methods: We used a quantitative cross-sectional analysis to evaluate a sample of 511 SBAs, all female, from 276 sub-health posts (SHP), health posts (HP), primary healthcare centers (PHC), and district and regional hospitals in the mountain, hill, and terai districts of Nepal. Any SBA actively employed by one of these health facilities was included. SBAs who had received less than three months of training were excluded. Outcomes were measured using SBAs’ scores on a standardized knowledge assessment, clinical skills assessment, and monthly delivery volume, particularly as it compared with the WHO’s recommendation for minimum monthly volume to maintain competence. Results: SBAs on average exhibit a deficiency of both knowledge and clinical skills, failing to meet even the 80-percent standard that is required to pass training (knowledge: 75%, standard deviation 12%; clinical skills: 48%, standard deviation 15%). Moreover, SBAs are conducting very few deliveries, with only 7 percent (38/511) meeting the minimal volume recommended to maintain competence by the WHO, and a substantial fraction (70/511, 14%) performing an average of no monthly deliveries at all. Conclusions: Taken together, our findings suggest that while countries like Nepal have made important investments in SBA programs, these healthcare workers are failing to receive either effective training or sufficient practice to stay clinically competent and knowledgeable in the field. This could in part explain why institutional deliveries have generally failed to deliver better outcomes for pregnant women and their babies. [ABSTRACT FROM AUTHOR]

Introduction: Antepartum depression is a contributing factor for adverse maternal and perinatal outcome. The study aimed to assess the antepartum depressive symptoms in selected public health facilities of Nepal. Methodology: This is a mixed-method cross-sectional study that included 143 pregnant women attending the antenatal checkup in four public health facilities of Kathmandu. Edinburgh Postnatal Depression Scale (EPDS) tool with cut-off score > = 10 was used to assess the antepartum depressive symptoms. Bivariate and multivariable analysis was carried out to identify factors associated with the depressive symptoms. Further semi-structured interviews were conducted with 12 pregnant women identified with the depressive symptoms. Result: Of the total 143 pregnant women, 26 (18%, CI at 95% 12.6–25.5) reported depressive symptoms. Multivariable analysis reported higher odds of antepartum depressive-symptoms with health problem, early gestational age, sex preference, and spousal alcohol intake. Thematic analysis of qualitative data further revealed participants’ apprehension on; birth outcome, a family expectation of male child, inadequate support from the family/husband and disturbed family environment. Conclusion: Notable proportion of pregnant women were reported with antepartum depressive symptoms. Women’s perception on patriarchal values for childbirth was revealed to be important factor for the depressive symptoms. The study draws an attention to a need for screening for antepartum depression into primary health care system. Strengthening ongoing efforts on gender equity could contribute the psychological well-being of pregnant women. [ABSTRACT FROM AUTHOR]

Background: In low-income countries, care for people with mental, neurological, and substance use (MNS) disorders is largely absent, especially in rural settings. To increase treatment coverage, integration of mental health services into community and primary healthcare settings is recommended. While this strategy is being rolled out globally, rigorous evaluation of outcomes at each stage of the service delivery pathway from detection to treatment initiation to individual outcomes of care has been missing.Methods and Findings: A combination of methods were employed to evaluate the impact of a district mental healthcare plan for depression, psychosis, alcohol use disorder (AUD), and epilepsy as part of the Programme for Improving Mental Health Care (PRIME) in Chitwan District, Nepal. We evaluated 4 components of the service delivery pathway: (1) contact coverage of primary care mental health services, evaluated through a community study (N = 3,482 combined for all waves of community surveys) and through service utilisation data (N = 727); (2) detection of mental illness among participants presenting in primary care facilities, evaluated through a facility study (N = 3,627 combined for all waves of facility surveys); (3) initiation of minimally adequate treatment after diagnosis, evaluated through the same facility study; and (4) treatment outcomes of patients receiving primary-care-based mental health services, evaluated through cohort studies (total N = 449 depression, N = 137; AUD, N = 175; psychosis, N = 95; epilepsy, N = 42). The lack of structured diagnostic assessments (instead of screening tools), the relatively small sample size for some study components, and the uncontrolled nature of the study are among the limitations to be noted. All data collection took place between 15 January 2013 and 15 February 2017. Contact coverage increased 7.5% for AUD (from 0% at baseline), 12.2% for depression (from 0%), 11.7% for epilepsy (from 1.3%), and 50.2% for psychosis (from 3.2%) when using service utilisation data over 12 months; community survey results did not reveal significant changes over time. Health worker detection of depression increased by 15.7% (from 8.9% to 24.6%) 6 months after training, and 10.3% (from 8.9% to 19.2%) 24 months after training; for AUD the increase was 58.9% (from 1.1% to 60.0%) and 11.0% (from 1.1% to 12.1%) for 6 months and 24 months, respectively. Provision of minimally adequate treatment subsequent to diagnosis for depression was 93.9% at 6 months and 66.7% at 24 months; for AUD these values were 95.1% and 75.0%, respectively. Changes in treatment outcomes demonstrated small to moderate effect sizes (9.7-point reduction [d = 0.34] in AUD symptoms, 6.4-point reduction [d = 0.43] in psychosis symptoms, 7.2-point reduction [d = 0.58] in depression symptoms) at 12 months post-treatment.Conclusions: These combined results make a promising case for the feasibility and impact of community- and primary-care-based services delivered through an integrated district mental healthcare plan in reducing the treatment gap and increasing effective coverage for MNS disorders. While the integrated mental healthcare approach does lead to apparent benefits in most of the outcome metrics, there are still significant areas that require further attention (e.g., no change in community-level contact coverage, attrition in AUD detection rates over time, and relatively low detection rates for depression). [ABSTRACT FROM AUTHOR]

Background: Local people in the Himalayan region use a wide range of wild and non-cultivated edible plants (WNEPs) for food, spice, medicinal, and cultural purposes. However, their availability, use, status and contribution to livelihood security are poorly documented, and they have been generally overlooked in recent agro-biodiversity conservation and management programmes. The study aimed to investigate WNEP diversity and current status in a part of the Kailash Sacred Landscape--a transboundary landscape shared by Nepal, India and PR China--in terms of collection, use, management and conservation initiatives. Methods: Multiple methodologies and tools were used for data collection. A series of participatory tools (45 key informant interviews, 10 focus group discussions, a crop diversity fair, direct observation of species through a transect walk and rapid market assessments) was followed by a household survey (195 respondents) and complemented by a literature review. Results: The study recorded 99 WNEPs belonging to 59 families of which 96 were angiosperms, one gymnosperm and two pteridophytes. Species were used for food, spice, medicine, rituals and income generation. Thirty-five species had multiple uses, including these: 40 species were used for fruit and 31 for vegetables. WNEPs contribute significantly to daily food requirements, especially the vegetables. The use value of Dryopteris cochleata was found highest (0.98) among frequently used vegetable species. The values of informant consensus factor were found maximum for worms in the stomach (0.99) and minimum for skin disease treatment (0.67). Nearly 85% of households depended exclusively on WNEPs for at least more than a month per year. Results on the importance and use of different species, gender roles in WNEP activities and conservation approaches are presented. Conclusions: People living in the Kailash Sacred Landscape depend significantly on WNEPs, and this is especially critical in times of food shortage. The WNEPs have considerable potential as an important supplement to cultivated food crops. Farmers prioritise species with multiple use values and popular vegetables. However, there are numerous challenges and interventions needed to ensure conservation and management of species and their continued availability to support food security and local livelihoods. [ABSTRACT FROM AUTHOR]

This paper discusses research and development work currently being conducted with universities in Bhutan and Nepal to design appropriate systems for distance and distributed learning courses among a network of campus sites. Although working from a high level of awareness of pedagogic skills, staff in the region face two significant impediments in the adoption of a more open culture of learning. Firstly, Internet access is improving rapidly, but is still generally too weak and inconsistent to allow any reliance on net-based learning solutions. Secondly, the academic culture is resistant to the recognition of the value of open-learning degrees, with subsequent difficulties in re-designing course materials for a more educationally flexible, student-centred learning environment. Some current pilot initiatives in distributed learning are described. Methods for addressing these two impediments are discussed. [This article was published in the theme issue on "Changing Faces of Open and Distance Education in Asia."]

Background: Over 133,000 children present to hospitals with Acute Encephalitis Syndrome (AES) annually in Asia. Japanese encephalitis (JE) accounts for approximately one-quarter of cases; in most cases no pathogen is identified and management is supportive. Although JE is known to result in neurological impairment, few studies have examined the wider impact of JE and AES on patients and their families. Methodology/Principal Findings: Children (aged 1 month–14 years) with AES were assessed 5–12 months after discharge from two Nepali hospitals. Assessment included clinical examination, the Liverpool Outcome Score (LOS) - a validated assessment of function following encephalitis, questionnaires about the child's social participation since discharge, and out-of-pocket costs to the family. Children were classified as JE or 'other AES' based on anti-JE virus antibody titres during acute illness. Contact was made with the families of 76% (73/96) of AES children. Six children had died and one declined participation. 48% (32/66) reported functional impairment at follow-up, most frequently affecting behaviour, language or limb use. Impairment was more frequent in JE compared to 'other AES' cases (68% [13/19] versus 40% [19/47]; p = 0.06). 49% (26/53) had improvement in LOS between discharge and follow-up. The median out-of-pocket cost to families, including medical bills, medication and lost earnings was US$ 1151 (10 times their median monthly income) for children with severe/moderate impairment and $524 (4.6 times their income) for those with mild/no impairment (P = 0.007). Acute admission accounted for 74% of costs. Social participation was limited in 21% of children (n = 14). Conclusions/Significance: Prolonged functional impairment was common following AES. Economic impact to families was substantial. Encouragingly, almost half the children improved after discharge and most reported sustained social participation. This study highlights a need for long-term medical support following AES. Rationalisation of initial expensive hospital treatments may be warranted, especially since only supportive treatment is available. Author Summary: More than 133,000 children present annually to hospitals in Asia with clinical features of acute brain infection (Acute Encephalitis Syndrome [AES]). Japanese encephalitis accounts for one-quarter of cases in Asia. With no specific treatments for AES, management is largely supportive. AES commonly causes neurological problems. However, few studies have examined long-term outcome or the economic cost of AES. We followed up 72 Nepali children 5–12 months after acute hospital admission for AES and studied their neurological function, social participation and the out-of-pocket costs to the family. At follow-up, 6 children had died and 48% of survivors had impaired function. Behaviour, language or limb impairments were common. Encouragingly, almost half the children reported improved function at follow-up compared to hospital discharge. The economic impact was substantial; $1151 US dollars (10 times their monthly income) among families with children suffering severe/moderate impairment. Acute admission represented 74% of total costs. Few families reported limitations in their child's social participation. The functional problems experienced by these children highlights their need for long-term medical support. The substantial economic costs to families suggest rationalisation of acute care costs may be warranted. Families reported their child maintaining social participation, implying a positive attitude to social engagement. [ABSTRACT FROM AUTHOR]

We describe volumetric changes in three benchmark glaciers in the Nepal Himalayas on which observations have been made since the 1970s. Compared with the global mean of glacier mass balance, the Himalayan glaciers showed rapid wastage in the 1970s-1990s, but similar wastage in the last decade. In the last decade, a glacier in an arid climate showed negative but suppressed mass balance compared with the period 1970s-1990s, whereas two glaciers in a humid climate showed accelerated wastage. A mass balance model with downscaled gridded datasets depicts the fate of the observed glaciers. We also show a spatially heterogeneous distribution of glacier wastage in the Asian highlands, even under the present-day climate warming. [ABSTRACT FROM AUTHOR]

The south Asian region (SAR) is home to 1·74 billion people, corresponding to 22% of the global population. The region faces several challenges pertaining to changing epidemiology, rapid urbanisation, and social and economic concerns, which affect health outcomes. Primary health care (PHC) is a cost-effective strategy to respond to these challenges through integrated service delivery, multi-sectoral action, and empowered communities. The PHC approach has historically been an important cornerstone of health policy in SAR countries. However, the region is yet to fully reap the benefits of PHC-oriented health systems. Our introductory paper in this Lancet Series on PHC in the SAR describes the existing PHC delivery structure in five SAR nations (ie, Bangladesh, India, Nepal, Pakistan, and Sri Lanka) and critically appraises PHC performance to identify its enablers and barriers. The paper proposes investing in a shared culture of innovation and collaboration for revitalisation of PHC in the region., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Preventing modern slavery is of global interest, but evidence on interventions remains weak. This paper presents findings from a 5-year theory-based evaluation of an empowerment and knowledge-building intervention to prevent the exploitation of South Asian female migrant workers. The evaluation used realist evaluation techniques to examine the intervention mechanisms, outcomes, and context. Findings from qualitative and quantitative data from Nepal, India, and Bangladesh indicate that the intervention mechanisms (trainings) were not well-targeted, not delivered by appropriate trainers, and did not address participants' expectations or concerns. The outcomes of empowerment and migration knowledge were not achieved due to poor integration of context-related factors, flawed assumptions about the power inequalities, including barriers preventing women from asserting their rights. Ultimately, interventions to prevent exploitation of migrant workers should be developed based on strong evidence about the social, political, and economic realities of their migration context, especially in destination settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Zimmerman, Mak, Pocock and Kiss.)

Open burning of crop residue is an important source of air pollution which is poorly characterized in South Asia. Currently, the gridded inventory reported by Global Fire Emissions Database for biomass burning including open burning of crop residue are of coarse resolution (0.25° × 0.25°), and may not be appropriate for a simulation for Nepal. This study develops a comprehensive high resolution (1 km × 1 km) gridded model-ready emissions inventory for Nepal to understand the spatial characteristics of air pollutant emissions from open burning. We estimate the national air pollutant emissions from crop residue burned between the years 2003 and 2017. The best available data on agricultural production, residue consumption patterns, agricultural burning parameters and emission factors were derived from secondary sources. The Monte Carlo method was used to estimate uncertainties. The mass of crop residue burned in 2016/17 was 2908 Gg (61-139%), which was 22% of the dry matter generated that year. By multiplying the burned crop residue mass by emission factors, the air pollutant emissions were estimated as 4140 for CO 2 (56-144%), 154 for CO (4-196%), 6.5 for CH 4 (7-193%), 1.2 for SO 2 (60-140%), 24.5 for PM 2.5 (30-170%), 8.6 for OC (38-162%), 2.2 for BC (-1-201%), 7 for NO x (54-146%), 22.5 for NMVOC (8-192%) and 2.7 for NH 3 (3-197%) in unit of Gg yr -1 . More than 80% of air pollutants were generated during the months of February to May from the open burning of crop residue. The findings of this paper indicate that substantial reduction in open field burning would dramatically improve air quality in both the Terai region and other parts of Nepal and help reduce negative health impacts associated with the open burning of residue such as premature deaths, respiratory disease, and cardiovascular disease., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

"The purpose of this paper is to extend...previous research in order to analyse the district-level variations in the timing of family formation in Nepal. The main hypothesis examined is that the district-level variations in the timing of family formation are determined principally by ethnicity, independent of socio-economic factors. It is surmised, therefore, that the district-level variations are not randomly distributed among sub-populations but are differentiated by ethnic characteristics in the districts." The full text of this article is available electronically through www.undp.org/popin., (excerpt)

"This paper presents a new data collection method, called the Neighborhood History Calendar, designed to collect event histories of community-level changes over time. We discuss the need for and the uses of this method. We describe issues related to the design of instruments, collection of data, and data entry. We provide detailed examples from an application of this method to the study of marriage, contraception, and fertility in rural Nepal. The paper addresses applications of this same technique to other settings and research problems. We also extend the technique to collection of other forms of contextual-history data, including school histories and health service histories. Finally, we discuss how Geographic Information System (GIS) technology can be used to link together multiple sources of contextual-history data.", (excerpt)

This paper examines demographic and socioeconomic forces in high isolated parts of the world. These regions were not always isolated; they were once the centers of their own particular worlds which, in some cases, were complex civilizations. It is their relegation to the very periphery of the modern world that is the principal theme of this paper. Population migration, both into and out of these areas, has played a vital role in linking mountainous regions to the wider world. Particular attention is paid to the part played by the traditional mobility patterns and by the resource base of the mountains in the transformation of integral, self-sufficient cultures into dependent, subservient part-cultures, the regions of refuge. The effect of population pressure and the development of outmigration from the Andes of Peru is examined first and the analysis extended to the highlands of Papua-New Guinea and to several regions in the Himalayan arc to provide the background for a comparative study of regions of refuge.